Mod 8: Sclerotherapy, Prolotherapy, & Lubricants

Question 1

What is Sclerotherapy?

Answer 1

Sclerotherapy involves the injection of a solution (usually salty) into a tissue such as vein or nerve.
Causes irritation in the lining of blood vessels, lymph vessels and nerves.
Leading to blood in vessels clotting, and to desiccate

Question 2

Sclerotherapy remains the primary treatment for small vessel varicose disease of the foot and lower extremity but what do this include?

Answer 2

Telangiectasias
Venulectasias
Reticular Ectasia’s

Question 3

What are Telangiectasias?

Answer 3

Red
Flat vessels
1mm or smaller in diameter.

Question 4

What are Venulectasias?

Answer 4

Blue
Sometime distended above the skin
2mm or smaller in diameter

Question 5

What are Reticular Ectasias?

Answer 5

Reticular veins
Cyanotic Hue
2-4mm in diameter

Question 6

Which vessels respond best to Sclerotherapy, LARGE or SMALL?

Answer 6

SMALL

Question 7

What are the major indications for using Sclerotherapy?

Answer 7

Improve cosmetic appearance
Reduce associated symptoms such as burning and pain.
To Rx remnant tributaries after endovenous laser ablation of Saph or truncal vessel.

Question 8

Contra-indications to Sclerotherapy are?

Answer 8

Pregnancy
Thrombophlebitis
Pulmonary emboli
Hypercoagulable states
Allergy to Sclerosing agent

Question 9

Which Diagnostic method is used to diagnose veinous disease?

Answer 9

Duplex Ultrasonography

Question 10

Visual Sclerotherapy is what?

Answer 10

Injections without the use of Ultrasonography

Question 11

Duplex guided Sclerotherapy (endovenous chemical ablation) is what?

Answer 11

Injection guided with Duplex Ultrasonography

Question 12

The most common agents used in Sclerotherapy are what?

Answer 12

Hypertonic Saline (23.4%)
Sodium Tetradecyl Sulphate
Polidocanol
Chromated Glycerin

Question 13

Should Sclerotherapy start with proximal or distal vessels?

Answer 13

Proximal: Varicose veins
Reticular veins
Talengeictasias

Question 14

Ambulation should begin how soon after injection and compression bandage is applied?

Answer 14

IMMEDIATELY

Question 15

What gauge needle is best used for Sclerotherapy?

Answer 15

30g bevel up to gauge depth

Question 16

If severe pain presents this could indicate what? and how can this be alleviated?

Answer 16

Extravasation of WBC

Injecting the site with Sodium Chloride or LA will help dilute the Sclerosant.

Question 17

The areas at highest risk of ulceration are where?

Answer 17

Pretibial

Ankle

Question 18

What are the usual injection sizes? and at what interval spacing?

Answer 18

0.1-0.4ml

2-3cm intervals

Question 19

Graduated compression stocking (class 1) of 20-30mmHg should be worn for the 1st night, TRUE or FALSE? then for how long after Rx?

Answer 19

TRUE

1-3 weeks depending on vessel size

Question 20

Lower extremity exercises are to be performed immediately after Sclerotherapy however how long should aggravated exercise be avoided for?

Answer 20

4 weeks

Question 21

Compression garments reduce the incidence of transient hyperpigmentation and edema, TRUE or FALSE?

Answer 21

TRUE

Question 22

Superficial Thrombophlebitis is rare but can be treated with?

Answer 22

Compression

NSAIDS

Question 23

What is a possible cause of tissue necrosis?

Answer 23

Extravasation

Injection into an arteriole

Question 24

Massage and topical 2% nitroglycerin ointment are Rx for what?

Answer 24

Shiney white blanching associated with injection into an arteriole or spasm

Question 25

Describe alcohol ablation of a mortons neuroma?

Answer 25

Ethanol is injected around the Nerve causing neurolysis, through dehydration, necrosis, and precipitation of protoplasm

Question 26

What is the preparation of 4% ethanol sclerosis therapy?

Answer 26

2ml 4% absolute ethanol alcohol
48mls of 2% Xylocaine with epinephrine 1:100,000
1ml of this mix is injected for 5-7 weeks

Question 27

Prolotherapy works by?

Answer 27

Claims to strengthen inadequate ligaments, tendons, and produce cartilage by injecting them with an irritant to induce fibroblastic hyperplasia.

Question 28

Use of steroids is con current to Prolotherapy because of what?

Answer 28

Prolotherapy induces inflammation and steriods reduce inflammation.

Question 29

Prolotherapy preparations include?

Answer 29

P2G (phenol, glucose, glycerin)

Dextrose

Question 30

OA can now be Rx by intra-articular injection of a lubricant, what is this know as?

Answer 30

Viscosupplementation

Question 31

Most commonly used agent for viscosupplementation is?

Answer 31

Hyaluronic acid (Hyalgan, Synvisc)

Question 32

HYALGAN and SYNVISC are used in injections to a single joint and come in pre filled single use syringes but what is their frequency?

Answer 32

HYALGAN - 3-5 injections 1 week apart.

SYNVISC - 3 injection 1 week apart.

Question 33

Injection technique for Lubrican injection is what?

Answer 33

Strict sterile technique (not to use disinfectants containing quanternary amonium)
Use 18-22g needle to draw as much fluid from joint as poss
use different 18-22g needle to inject Viscosupplement.
*Steroids or LA should not be mixed with viscosupplement to prevent dilution
LA can be used to numb area of injection

Question 34

Care should be taken to avoid IV injection of lubricants, how might this present?

Answer 34

Rashes
Hives
Itching
Muscle pain/cramps
Flushing/swelling of face
Tachycardia
Nausea
Dizziness
Fever
Chills
Headache
Difficulty breathing
Swelling arms/legs
Rare cases decreased platelet level

Question 35

Following Lubricant injection post op information should include?

Answer 35

Information about possible side effects: Pain, swelling, restricted motion.
If necc - Rest, Ice, Heat, NSAIDS
Avoid High impact activity for 48hrs